February 26, 2010

The Health Care Summit

I watched a little, in the morning, for about an hour. I had awakened at 5 am anyway (one of those developments in the aging process, I presume), I was caffeinated on Peet's 91 Octane, and it was on TV. What the heck.

Prez O is getting better and better at whatever it is he's doing in all these meetings with Republicans. Is it strategic? It must be, at some level. I guess the idea is to show the Republicans up for the no-idea obstructionists they are. Although, in truth, once the idea was reached by the O Admin that the fix would consist of maintaining the present system of an unholy marriage between private, for-profit medicine and insurance with government involvement as regulator and partial reimbursor, the game was over anyway. It's just not going to work, because the fundamental premise is wrong. We're really the only modern, industrialized democracy that tries to do things this way, and it's a failure. If you read Paul Krugman's column today, you'll see he has contracted his hopes to a single point: no more "preexisting condition" exclusions. That's it. That's why he supports this bill, because it has that provision.

So while it looks like a lively argument between humane Democrats, and cold, callous Republicans, it's really an argument about which irrelevant approach ought to be passed or not passed, so that, respectively, the Democrats can claim they passed Health Care Reform, or the Republicans can claim that President Obama Has Met His Waterloo. I think the O Man was attempting to demonstrate, on TV, that his ideas are up against irrational obstruction, but that does not come through very clearly because he's championing a tepid, sell-out program in the first place.

I actually thought Tom Coburn had some interesting comments about "defensive medicine" and its contribution to cost overruns. Doctors perform most of their tests so they won't get sued for not performing them. He went on to estimate the cost for such an approach as "$850 billion per year." ?? If health care costs 17% of GDP (the usual number), then medicine in its various forms comes in at about $2.4 trillion. Coburn is saying that 1/3rd of all costs are waste because of the tort system. It's possible there's something to that. If you add wasteful spending to the condition in which the American patient presents himself to the doc in the first place (obese, diabetic, eating a regular diet of toxin-laced processed food), maybe we could begin to get a realistic picture of what's going on, and discover that socialized medicine would not be so terribly expensive after all, if coupled with tort reform and public health proactivism.

For my part, I've always thought that the whole system of private recovery for medical malpractice should cease. This is not to say that medical malpractice does not occur, because it occurs regularly. The question is whether our system of redress does more harm than good for society as a whole. Whether Coburn (who is a doctor) realizes it or not, his argument backs into the regulation of medicine as a public and social utility. Medicine should be regulated, with peer-group review of doctors as the enforcing agents, instead of trials by jury. The various boards of medical quality assurance should take over, and the tremendous savings to doctors allowed by never buying medical malpractice insurance again should in part form a compensation fund for victims of medical malpractice as determined by such panels or other administrative boards (similar to worker's comp). Then doctors could focus on competence and realism instead of looking over their shoulders, and leave it up to medical quality assurance to determine whether a doctor should retain his license.

But as I say, I don't think yesterday's meeting will lead to any paradigm shift, and that's the kind of transformation we need. A colloquy of pontificators is not a method for devising intricate or creative work. Maybe when Woody Allen, Mel Brooks, Carl Reiner, Neil Simon, Larry Gelbart and Sid Caesar sat around a table coming up with ideas for "Your Show of Shows," this sort of collaboration provided a creative synergy where the whole was greater than the sum of the parts. When it's Lamar Alexander and John Boehner on one side, and Nancy Pelosi and Harry Reid on the other, not so much.

February 25, 2010

The patient is still in Recovery

There's a new gadget over there on the right you can use to see what's going on with the Recovery Act, or ARRA, right in your home town. My area has saved (or created) 62 jobs and received $34 million in various loans, grants and contracts. Go ahead, plug in your ZIP code and feel the surge of hope - it's happening!

ARRA is still in its early stages. So far, with about 35% of the money (in the three categories of tax breaks, grants/loans/contracts, and entitlements) out the door, we've saved (or "created") about 600,000 jobs. The total price of ARRA was $787 billion, as you'll recall, so we've accounted for about $275 billion so far. I know that the American Recovery & Reinvestment Act was more than just about job creation. It was also about satisfying the Republican mania for reducing taxes, and, fair-minded as always, President Obama saw to it that ARRA's single largest category concerns tax breaks. This might seem odd in a country where the federal budget is $3.5 trillion and the net haul from taxation is around $2.2 trillion, especially when you consider that whatever ARRA cost, the amount was going to be "borrowed" by the Treasury Department. That one might have stopped John Maynard Keynes, not to mention a Zen Master, in his tracks. ("How do we fill the void of nothing? By giving the nothing away.")

Okay, given the caveat above (it's not just about jobs), we can still do some simple long division (or "Calculator" on my tool bar can) and figure that each of the 600,000 jobs cost about $458,000. My first reaction is selfish: I really want one of those jobs. But it's all so much more complicated than that, of course.

Still, you kind of wonder. Is that really bang for the buck? My guess is this: the problem with ARRA, as with most things the Federal government in now trying to do, is that (as always) the attempted remedy came so late in the game that there simply wasn't time (or the money) to do anything other than leverage the federal government's (waning) ability to borrow money (or print it) in order to ship it out to cities and states to keep the police, firefighters and teachers on the job, and to use whatever was left to extend the already extended unemployment checks of the nation's out-of-work millions.

For my part, I don't begrudge the recipients any of that. It's a little hard to follow where all the money went, but a ton must have gone as unemployment subsidies, COBRA assistance and other not-very-exciting but very essential stuff. Besides, Paul Krugman thought it was the answer to life itself (although he was disappointed that it wasn't "bigger." How much bigger should it have been? He doesn't say, but he knows this was too small.). Maybe when fully deployed ARRA will create or save 1.8 million jobs, which is pretty good (although nowhere near the number of jobs lost in the last two years), and then certain longer-range facets of the funding, such as renewable energy and energy efficiency (about $16.8 billion), may spark more employment down the road. One can hope. It's a shame the USA is not in a position simply to devote the whole $700 billion to visionary transformation, especially of energy and transportation; if you look at another link on the right, you'll see we have spent about this amount, so far, in Iraq.

Not where our priorities are, I'm afraid. So it's all crisis management, throwing money at disasters and hoping against hope the economy simply goes into spontaneous remission, because we probably can't do this again. And when all this money is gone, and we've still got these problems of underfunded states and municipalities?

I guess we'll think of something.

February 22, 2010

Whether ir can happen here or not, I don't want it to

I've been reading Germany 1945 by Richard Bessel, a professor of Modern History at York University. Bessel, like Richard Evans (who wrote the amazing trilogy on the Third Reich), is a tirelessly thorough historiographer who zeroes in on one discrete point in time, the year the war ended in Germany, and tells you everything that happened in that awful place. It's not too much to say that blood ran in the streets. Germany was a slaughterhouse of its own making, and if it was the intent of the Allies, as Churchill said, to bring the war home to the German people, they succeeded beyond their wildest imagination. What's remarkable is that the German Wehrmacht suffered about 1/4th of its total deaths in the period between January 1, 1945 (when the last German offensive, the Battle of the Bulge, failed) and the cease-fire in early May. The Germans lost more than one million men during these 4-1/2 months, most of them on the Eastern Front as the Soviets brought the full force of their armies to bear in a rush toward Berlin. The Germans lost more men in January, 1945 (450,000) than did the United States during the entire course of the war (the same statistic is true for the British).

It was the crazed fanaticism of Hitler and his High Command, sealed up in their bunker, that caused all this senseless, horrible slaughter, as German civilians rushed West in an attempt to escape the wrath of the feared Russians, as bombs from the British and Americans rained down from above (in skies no longer protected by the Luftwaffe or anti-aircraft guns), and as the destroyed German infrastructure took its toll in starvation and disease during a very cold winter. The SS and Gestapo enforced the Fuhrer's dictates, hanging and shooting German deserters and stragglers, and also pressing old men and young boys into the Volkssturm to defend German cities in a completely lost cause.

While all this was going on, the German SS was about its usual murder and mayhem, forcing concentration camp survivors on long death marches away from the front, in the bitter cold without food or shelter, killing many or most of them in pointless relocations. The roads were jammed throughout the country with desperate refugees, starving prisoners, panicked soldiers, and as communications were destroyed and the leadership disappeared, Germany descended into complete anarchy. It was utter hell on Earth.

I think about things like that when I read the slightly giddy anticipation of "civil war" in columns such as that written by James Howard Kunstler Monday on his Clusterf**k Nation website. He thinks that dispossessed Americans, accustomed to their suburban comforts, easy access to gasoline, cable TV, et cetera, will engage in open rebellion and violence when it becomes apparent these things are going away and will not be coming back. All I can say is: I sure hope not. I think that's one of the values of reading history - if we think, for one minute, that a Germany 1945 scenario is something devoutly to be wished, that it would "shake things up" in some sort of good way, then we really have lost our minds. I don't think it's a good thing to romanticize, and it's irresponsible even to egg on. I realize that such over-the-top predictions draw hits to the website, but...you know, do your realize what we're actually talking about here?

One thing that might save us, in a paradoxical way, is the innate passivity of the general populace. We'll always have isolated incidents of acting-out, and occasionally (as with the Rodney King riots and the Watts riots of the Civil Rights era) even full-fledged conflagrations based upon perceived injustice and long-nurtured resentment. But why would the general populace resort to violence in a coordinated or even factional way, when the populace will not even use the electoral powers it already possesses to change anything it wants? A recent Rasmussen poll demonstrated that 79% of the American citizenry does not believe that Congress does its work with the interests of the American people as its foremost priority. To begin with, that's pretty astute, I think. But what's remarkable is that Americans will not take the next logical step and simply vote out everybody in office, and break, once and for all, the connections between incumbents and their corporate paymasters (the "535 Plan"). Vote for anyone, your sister-in-law, the guy behind the deli counter, your favorite barista, but just put in all new people, of whatever party, and start the hell over. Never happens, never going to happen, and probably the main reason is the fundamental atomization of the American Volk. There is no means of general organization, other than the central government itself, and everyone watches this government we supposedly despise for cues on what to do next.

So Americans are mired in disgust, and some people (the Austin suicide pilot, e.g.) take it to the next level. But mostly we just complain, watch TV and surf the Net. About 20% of the work force is underemployed. That's a huge cohort of dissatisfied people. Yet nothing much happens.

Maybe we're too civilized, maybe we're too apathetic, maybe we just don't know what to do. Kunstler and the Apocalypto-Freaks revel in the fantasy we can have our very own Third Reich. Sure hope not. Sure hope we come through all this intact.